Provider Demographics
NPI:1477675106
Name:CAPITAL DISTRICT PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:CAPITAL DISTRICT PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-395-9215
Mailing Address - Street 1:2317 BALLTOWN RD
Mailing Address - Street 2:SUITE 204 NORTH
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-2339
Mailing Address - Country:US
Mailing Address - Phone:518-395-9215
Mailing Address - Fax:
Practice Address - Street 1:2317 BALLTOWN RD
Practice Address - Street 2:SUITE 204 NORTH
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-2339
Practice Address - Country:US
Practice Address - Phone:518-395-9215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicaid